Reliability of emergency medical field triage. Exemplified by traffic accident victims

Background. Trauma is the leading cause of death in the patient group under 40 years of age. Within the prehospital management of seriously injured trauma victims the accuracy of the field triage by emergency physicians is of utmost importance. Objective. The aim of this study was to determine the accuracy of prehospital emergency physician field triage in road traffic accident victims. Material and methods. The study involved a retrospective analysis and comparison of prehospital and inhospital trauma records of road traffic accident victims treated by a Helicopter Emergency Medical Service (HEMS) team and transferred to a level I trauma centre. A comparison of prehospital and inhospital diagnostic findings was carried out according to an anatomical score (AIS). Results. Included in the analysis were 479 patients with a mean age of 37.0 +/- 18.2 years, males 65.8%, mean injury severity score (ISS) 15.5 +/- 13.5, ISS >16 in 41,1% and mortality 7.3%. The leading causes of injury were motor vehicle accidents (56.2%), followed by motorcycle (24.0%) and bicycle accidents (11.6%) as well as truck accidents (4.0%) and pedestrian accidents (4.2%). The most common body regions injured (AIS >= 3) were the chest (37%), head (25.1%) and lower extremities (16.7%). A correct prehospital field triage by emergency physicians was found for injuries with an AIS >= 3 of the head 77%, chest 69%, abdomen 51%, pelvis 49%, extremities 70%, neck/cervical spine 67% and thoracic/lumbar spine 70%. Overlooked injuries in the prehospital setting (AIS >= 3) comprised predominantly injuries of the trunk (chest 12.6%, abdomen 16.9% and pelvis 15%). Overlooked injuries were found significantly less for the head in patients with a Glasgow Coma Score <= 8 on arrival at the scene (5.4% versus 19%, p=0.015), for the chest in patients with a SpO2 <= 96% on arrival at the scene (18.1% versus 35.5%, p=0.004) and for the abdomen in patients with a systolic blood pressure <90 mmHg on arrival at the scene (28.6% versus 52.5%, p=0.025). Conclusion. Accurate field triage in seriously injured road accident victims, even by trained physicians, is difficult. This pertains especially to injuries to the abdomen and the pelvis. For the field triage a combination of anatomical and physiological criteria as well as the mechanism of injury should be used to increase accuracy.